Hep B Issues

[sd1234]

Hello,

I am a 31-yr old female of asian descent, and was recently diagnosed w/Chronic Hepatitis B (acquired from birth):

My lab results are as follows:

HBV DNA Quant:  > 110,000,000 IU/mL (more than the test could detect)
ALT: 475
AFP, Tumor Marker: 8.8 ng/mL (Normal 0-8)
ANA Titer (positive) ... 1:640 homogenous and 1:640 nucleolar
HBsAg: Positive
HBeAg: ? was missed during testing, but assuming positive since my anti-HBe was negative
All other LFTs (Bili, Alb, Alpha-1, etc.) were all on the high end of normal
PT/PTT: Normal (again on the high end)

I recently began taking Baraclude (0.5 mg) and have a biopsy scheduled in two weeks.

I have the following questions:

(1) For someone w/such a high viral load, does anyone know the efficacy of Baraclude?  I realize I need to just see what the results are after six weeks, but how will I know if it's working since my baseline HBV DNA was so so high to begin with?  I expect to see a decrease in ALT no matter what, since I used to have 3-4 drinks/week, but is anyone aware of any HBV DNA tests that are more specific?  

(2) Also, I know that antibodies can show up in Hep B patients b/c your body starts producing antibodies in response to the Hep B virus that mimic Hep B in your liver.  Is this anything to be concerned about since my ANA titer was relatively high?  I have also read about extrahepatic manifestations that can occur as a result of having Hep B ... should I ask for a Rheumatoid Factor test, or other antibody panels (C3, C4, etc.)?

(3)  Does anyone have experience with obtaining a genotype for their HBV?  Is this something that is typically covered by insurance?

(4) Finally, I had an ultra-sound, which came out clear ... is there anything else I can do to prevent developing HCC aside from reducing viral load and cutting off all alcohol?

I realize that these are questions for my doctor, but I am just looking for some other sources of information.

Thank you in advance for any input you may have!

[sd1234]

So, I just received my liver biopsy results:

Mild portal chronic inflammation w/mild to moderate interface hepatitis (grade 2-3/4)
Few small foci of lobular activities
Periportal fibrosis and focal bridging fibrosis (stage 2-3/4)

In response to this, my doctor just said I would continue w/the Baraclude, and if my blood work is not improved we are going to explore additional treatment options.  Does anyone know the clinical significance of these results?  Thanks.

[zellyf]

Do not worry about the light to moderate drinks of the past. Chances are they did no damage.  It would not be recommended, however, given your high ALT and viral load, to continue...as you already know.

Time and gender are on your side as far as HCC is concerned.  There isn't much you can *do* other than whatever you would do to prevent any kind of cancer.  Diet and exercise being the primary components of that defense.

[sd1234]

Thank you for your input.  I asked my doctor about the ANA, and he told me he thinks it is just a response to the HBV.  Hopefully, he's correct.  

As far as developing HCC, I agree that I have youth on my side ... however, I have read many scary testimonials proving otherwise (especially since I have been a light to moderate drinker for the past 11-12 years).  Maybe I should stop doing so much research and tend to my mental health :)

Thanks again.

[bram44]

1.  For e-Antigen positive patients high viral load is common. The good news is your treatment can stop once you sero-convert (become e-antigen negative).

Please refer to the following link, which may help you understand more about treatment.

http://hepb.org/pdf/2009_US_Pocket_Guide_Complete_Booklet.pdf

Baraclude is a very good drug. Viread is another one which gives faster results.

2. ANA test is to ensure there are no "auto immune disorders". USually doctors order ANA and SMA (smooth muscle antibody) tests before they put patients on treatment. You need to discuss this with your doctor.

3. My doctor ordered geno-type test. This test helps in predicting drug resistance. My insurance covered it, so I think it is covered. BTW - it is not that expensive (less than $150 payment from insurance).

4. Since you are going for biopsy, that should be of great help.

Given your age, you developing HCC is remote. But try reducing alcohol in take.